Gut Microbiome-based Therapeutics in Liver Cirrhosis: Basic Consideration for the Next Step

Area of Science:

• Gastroenterology
• Microbiology
• Hepatology

Background:

• Infections are a major cause of illness and death in liver cirrhosis, often linked to gut microbiome alterations.
• Fecal dysbiosis, characterized by pathogenic bacterial overgrowth and reduced beneficial bacteria, worsens with cirrhosis progression.
• Intestinal barrier disruption in cirrhosis leads to hyperpermeability, dysmotility, and bacterial translocation, exacerbating liver disease.

Purpose of the Study:

• To explore the role of gut microbiome dysbiosis in liver cirrhosis progression and complications.
• To review the efficacy of microbiome-based therapeutics, including probiotics, prebiotics, synbiotics, and antibiotics, in managing cirrhosis.
• To understand how gut microbiome alterations affect the gut-liver axis and influence liver disease outcomes.

Main Methods:

• Review of existing literature on gut microbiome in liver cirrhosis.
• Analysis of studies investigating the impact of dysbiosis on cirrhosis complications like hepatic encephalopathy and infections.
• Evaluation of therapeutic interventions targeting the gut microbiome, such as probiotics, prebiotics, synbiotics, and rifaximin.

Main Results:

• Cirrhosis is associated with significant gut dysbiosis, reduced short-chain fatty acid and secondary bile acid producers, and increased intestinal permeability.
• Bacterial translocation contributes to inflammation and affects metabolic and hemodynamic systems, worsening cirrhosis and its complications.
• Probiotic efficacy for hepatic encephalopathy is inconsistent, while prebiotics and synbiotics show more documented benefits. Rifaximin shows promise but lacks established indications.

Conclusions:

• Gut microbiome dysbiosis is a critical factor in liver cirrhosis pathogenesis and complications.
• Targeting the gut-liver axis through microbiome modulation offers a promising therapeutic strategy for cirrhotic patients.
• Further research utilizing metagenomic and metabolomic analyses is needed to optimize microbiome-based therapies for liver cirrhosis.